双腔起搏器时间间期基础教学课件.ppt

如何判断是A-A还是V-V基础间期？AEI触发心房脉冲， The Post-Ventricular Atrial Refractory Period (PVARP) is the period of time after a ventricular pace or sense when the atrial channel is in refractory. In other words, atrial senses outside of blanking that occur during this period are seen (and marked 揂R) on the marker channel), but do not initiate an AV interval. The purpose of PVARP is to avoid allowing retrograde P waves, far-field R waves, or premature atrial contractions to start an AV interval which would cause the pacemaker to pace in the ventricle at a high rate. The refractory period after a ventricular event (paced or sensed) is designed to avoid restarting of the V-A interval due to a T wave. Ventricular sensed events occurring in the noise sampling portion of the ventricular refractory period are seen (and marked 揤R?on the marker channel) but will not restart the V-A interval. The atrial channel is refractory following a paced or sensed event during the AV interval. This allows atrial senses occurring in the AV interval to be seen but not restart another AV interval . PMT(Pacemaker Mediated Tachycardia) * The sequence of an atrial intrinsic event being sensed, starting an SAV interval, timing out the SAV interval, and pacing in the ventricle can be referred to as tracking. If the atrial rate begins to increase and continues to increase, is it desirable to let the ventricle track to extremely high rates? No. It is desirable to limit the rate at which the ventricle can pace in the presence of high atrial rates. This limit is called the upper tracking rate. VSP由AP开启，VSP解决AP后的起搏后电位对于心室感知的影响；VSP避免在PAV间期内感知到干扰信号导致心室漏搏 * 肯定是，AP后正好有了一个早搏，所以110VSP感知床感知 发放VSP * Sigma是S，P，kappa Vp 如果有VSP 起搏心电图上的标记 心房导线靠近三尖瓣 最佳的AV间期对心室充盈，减少房室瓣返流，保持正常的心房压力及阻止不良的循环及神经体液反射都是很重要的。不恰当的AV间期所带来的血流动力学负面作用甚至大于一般的心室起搏。 * ?单腔起搏的劣势? AAI：心房发放脉冲 并能自行下传激动到心室；VVI：心室发放脉冲，丧失心房与心室收缩的同步、顺序、协调，因而是非生理性的。 ?双腔起搏的优势? 通?过AV的同步性，改善血流动力学，增加心输出量，最小化三尖瓣反流，保持心房的电学稳定 ?如何保持房室同步? 心房起搏AP 后 心室起搏VP的时间 心室的活动和心房相关 Studies have